HSJ's exclusive poll of one in four PCT chief executives and commissioning directors shows high levels of uncertainty over using FESC for commissioning, writes Alexis Nolan

Less than half of primary care trusts plan to use the Framework for procuring External Support for Commissioners to get help in improving their commissioning, according to an HSJ survey.

Our poll of 74 PCTs - including more than half of those in the North East, South Central, South East Coast, West Midlands and Yorkshire and the Humber strategic health authorities - shows that among sometimes strongly differing opinions between chief executives and commissioning directors, there is at least uniform uncertainty in whether they will be using FESC.

The views of the 40 chief executive respondents were generally more positive about the framework than those of the 38 commissioning directors. The chief executives showed more belief in FESC, higher levels of clarity on how the expertise of private sector companies could help improve commissioning, less demand for other support and higher expectations of success.

More than one in three PCT chief executives felt 'to a certain extent' that FESC was an appropriate way to help PCTs improve commissioning and more than one in five that it was better, at 'OK'. By contrast half of commissioning directors felt FESC was 'to a certain extent' appropriate and just 11 per cent that it was better at 'OK'.

While just 8 per cent of chief executives were unclear of how FESC might be used to improve commissioning, that level rose to more than one in three commissioning directors.

Both groups felt there were other ways in which they would rather get help in commissioning, although commissioning directors felt this more acutely (89 per cent) than chief executives (71 per cent). Those alternatives included more of an emphasis on the development of internal capability through training and education, more national information and support on best practice and service specifications and some resentment against private sector expertise.

'Following the McKinsey FFP [fitness for purpose] for PCTs conducted over the last 18 months at great expense in time and resources to PCTs/SHAs and not least taxpayers money, a recurrent commitment should now be made to the ongoing development of PCT commissioners (as identified in their FFP development programmes) as opposed to investing in external, commercial, for profit organisations who may be able to provide a particular expertise in the commissioning process but in my experience at greater expense and not along the whole pathway; that is of course unless they are able to recruit the knowledge held with NHS commissioning,' said one commissioning director.

Another said: 'There is a need for organisations to build their capacity and capability through various routes. We should not be aligned to one option. Learning and development will play a key role in building commissioning capacity and capability.'

To download more results from the poll, click here